A STUDY ON EVACUATION SIMULATION FOR GUIDING TOURISTS IN HIMEJI CASTLE BASED ON A SURVEY OF TOURISTS’ INTENTIONS IN EVACUATION AFTER EARTHQUAKE

Many tourists tend to visit historic areas. Nevertheless, their knowledge about these areas, disaster prevention, and evacuation is not sufficient. Japan has met with several large-scale disasters, namely the Great East Japan Earthquake in 2011, the Great Hanshin-Awaji Earthquake in 1995, and will potentially face the Nankai Trough Quake in the future. This paper, based on a survey of tourists’ intentions in evacuation after an earthquake in Himeji castle, shows an evacuation simulation and the measures for supporting tourists’ evacuation. Himeji Castle, the area investigated by this study, is one of the world heritage sites in Japan. First, this study revealed decision-making rules and used these to categorize tourists. This paper investigated the sources of information that tourists consider before starting evacuation. According to the results of the questionnaire survey, four groups were categorized by analytic hierarchy process and cluster analysis. As a result, many tourists set a high value on information from sign boards and staff of the Himeji castle before starting evacuation. Next, in a similar manner, using analytic hierarchy process, this survey found that many tourists consider information from signboard and staff when choosing evacuation routes, and the respondents were categorized into four groups using cluster analysis. Second, this study developed an evacuation simulation taking into account the tourists’ intentions about evacuation. This study used SOARS, Spot Oriented Agent Role Simulator, as a simulation platform and adopted a Spot-Link type model. Third, this study simulated six cases that have different evacuee flows near “Bizen-gate” and routes in sightseeing, and evaluated them by transition of the number of evacuees who were able to reach an evacuation area and the number of evacuees who could not move because of bottlenecks. As a result, we found two effective measures for guiding tourists

ACTN1 Mutations Cause Congenital Macrothrombocytopenia

Congenital macrothrombocytopenia (CMTP) is a heterogeneous group of rare platelet disorders characterized by a congenital reduction of platelet counts and abnormally large platelets, for which CMTP-causing mutations are only found in approximately half the cases. We herein performed whole-exome sequencing and targeted Sanger sequencing to identify mutations that cause CMTP, in which a dominant mode of transmission had been suspected but for which no known responsible mutations have been documented. In 13 Japanese CMTP-affected pedigrees, we identified six (46%) affected by ACTN1 variants cosegregating with CMTP. In the entire cohort, ACNT1 variants accounted for 5.5% of the dominant forms of CMTP cases and represented the fourth most common cause in Japanese individuals. Individuals with ACTN1 variants presented with moderate macrothrombocytopenia with anisocytosis but were either asymptomatic or had only a modest bleeding tendency. ACTN1 encodes α-actinin-1, a member of the actin-crosslinking protein superfamily that participates in the organization of the cytoskeleton. In vitro transfection experiments in Chinese hamster ovary cells demonstrated that altered α-actinin-1 disrupted the normal actin-based cytoskeletal structure. Moreover, transduction of mouse fetal liver-derived megakaryocytes with disease-associated ACTN1 variants caused a disorganized actin-based cytoskeleton in megakaryocytes, resulting in the production of abnormally large proplatelet tips, which were reduced in number. Our findings provide an insight into the pathogenesis of CMTP

ジゾク セイ シンボウサイドウ アブレーション ゴ ノ サイハツ ヨソク インシ ノ ケントウ : サボウ ケイタイ ・ サ シンジ キノウ ノ ユウヨウ セイ

持続性心房細動に対するカテーテルアブレーション(CA)治療後の再発予測を,術前の心エコー図検査から行い,その有用性について検討した.対象は2011 年1 月からの1 年間,心房細動(AF)に対し,初回CA を施行したAF 連続80 例のうち持続性AF32 例である.CA 前に経胸壁心エコー図検査(TTE)および経食道心エコー図検査(TEE)を施行し,各指標を計測し,術後再発予測因子を検討した.CA 後1 年で14 例(44%)にAF の再発を認めた.再発群は非再発群に比し,左房長径が有意に大きく,左心耳壁運動速度は先端と外側の陰性波計測値が有意に低下していた.多変量解析では左房長径および左心耳先端壁運動速度陰性波(LAAWV apex-d)がCA 後AF 再発の予測因子であった.ROC 曲線にて,左房長径はカットオフ値を58 mmとすると感度92.3%,特異度66.7%,LAAWV apex-d はカットオフ値を9.4 cm/s とすると感度78.6%,特異度83.3%で,両者共CA 後AF の再発を予測し得た.TTE およびTEE からCA 後の再発予測が可能であった.Background:Catheter ablation( CA) of persistent atrial fibrillation (PsAF) has been widely performed. However, echocardiographic predictions for the AF recurrence are not completely understood.Objective:The purpose of this study was to evaluate the value of both the left atrial( LA) longitudinal diameter and left atrial appendage wall velocity (LAAWV) for predicting AF recurrences after CA of PsAF.Methods: We retrospectively analyzed 32 patients with PsAF who had undergone CA. Both the transthoracic and transesophageal echocardiographic parameters, and clinical parameters were assessed.Results:During a one-year follow-up period, 14 patients (44 %) had AF recurrences after a single CA procedure. There was a significant difference in the LA longitudinal diameter (63±3.3 mm vs. 58±5.4 mm;p=0.0029) and LAAWV apex-d (7.9±2.1 cm/s vs. 11.7±3.0 cm/s;p= 0.0003) in the patients with and without AF recurrences. A multivariate analysis revealed that the LA longitudinal diameter (p=0.0247) and LAAWV apex-d (p=0.047) were significant predictors of arrhythmia recurrences. In the receiver operator curve analysis, a longitudinal diameter> 58 mm demonstrated a sensitivity of 92.3 % and specificity of 66.7%, and a LAATDI apex-d of 9.4 cm/s demonstrated a sensitivity of 78.6 % and specificity of 83.3%, in predicting an arrhythmia recurrence.Conclusion:The LA longitudinal diameter and LAAWV could be used as non-invasive pre-procedural predictors of arrhythmia recurrences after single CA procedures in patients with PsAF

Framingham Risk Score ト ドウミャク コウカ リスク ニ ツイテノ ケントウ

背景:冠動脈疾患において以前よりフラミンガムリスクスコア(Framingham Risk Score:FRS)は10 年以内の虚血性心疾患発症を予測することが知られている.また近年,冠動脈マルチスライスCT(MultisliceConputed Tomography:MSCT)により求められる冠動脈カルシウムスコア(Coronary Artery CalciumScore:CACS)や種々の炎症マーカーが冠動脈疾患予測因子として報告されている.目的:年齢,性別,総コレステロール値,High Density Lipoprotein Cholesterol (HDL-C)コレステロール値,収縮期血圧,喫煙の有無から簡易に求めることのできるFRS を算出し,FRS と冠動脈疾患各動脈硬化リスク因子について検討した.対象:2009 年6 月から2011 年9 月までに当院に虚血性心疾患精査目的に受診しMSCT および,冠動脈造影を施行した連続347 例(男性229 例,女性108 例)についてFRS を計測し15 以上の高リスク群(H 群)と15未満の低リスク群(L 群)に分類した.冠動脈造影における有病率と冠動脈疾患予測因子であるCT にて計測されるCACS,及び血液検査における炎症マーカーについて比較検討した.結果:対象はH 群149 例,L 群198 例に分けられた.冠動脈造影における冠動脈疾患有病率はH 群53.6%,L 群41.4%とH 群において有意に高値であった(P=0.023).CACS においてもH 群687.1±759.1,L 群489.8±725.6 とH 群において有意に高値であった(P=0.015).血液検査におけるマーカーにおいては高感度CRP(H 群 vs L 群:0.29±0.70 vs 0.17±0.29 mg/dl P=0.046)と酸化Low Density Lipoprotein Cholesterol(LDL)(H 群 vs L 群:110.2±47.0 vs 96.8±35.6 U/L P=0.007)において有意差を認めた.結語:FRS は簡便に計測でき,各種冠動脈疾患予測因子とも関連しており冠動脈疾患予測の一助となりうる可能性があると考えた.Background: The Framingham risk score (FRS) is widely used inclinical practice to identify subjects at high risk for developingischemic heart disease. However, FRS may not accuratelyidentify subjects at risk. Recently, coronary arterycalcium score (CACS) detected by multi-slice computedtomography (MSCT) and several atherosclerosis riskmarkers has been known to predict ischemic heart diseases.Subjects: The aim of this study is to clarify the relation betweenFRS and several coronary risk factors. We researched theclinical records of 347 patients who had been subjected toMSCT and coronary angiography( CAG) between Jun 2009and September 2011. We subdivided these patients by thevalue of FRS into a group H (n=149;FRS &#8805; 15) and agroup L( n=198;FRS<15), and examined the relationshipbetween FRS and the other coronary risk factors.Results: The prevalence of coronary heart disease by CAG wassignificantly higher in group H (53.6 %) than in group L(41.4%, p=0.023). CACS was significantly higher in groupH than in group L( 687.0±759.1 vs 489.8±725.6, p=0.015).In group H the level of high-sensitive CRP and MDL-LDLwere significantly higher than those in group L(0.29±0.70vs 0.17±0.29 p=0.046 and 110.18±47.0 vs 96.82±35.6 P=0.007).Conclusion: We suggest that the FRS is easy to calculate and usefulto predict ischemic heart disease compared with the othercoronary risk markers

コウド インスリン テイコウセイ ジョウタイ ニ オケル ヤクザイ ヨウシュツセイ ステント リュウチ ゴ サイキョウサク ノ ヨソク インシ ノ ケントウ

目的:虚血性心疾患に対する経皮的冠動脈形成術(Percutaneous coronary intervention:PCI)は有用な治療法として確立されている.薬剤溶出性ステント(Drug-eluting stent:DES)により,大きな問題であった再狭窄は減少したが,完全には克服されていない.最近糖尿病の前段階としてインスリン抵抗性が注目されており,再狭窄に影響を及ぼすことが示唆されている.今回我々はHomeostasis Model Assessment 指数(HOMA-IR)を用いてインスリン抵抗性の程度とDES 留置後の再狭窄の関連を検討した.方法:2007 年5 月から2010 年10 月までに待機的にPCI を施行しDES を留置した248 例について,HOMAIRより高度インスリン抵抗性を有する群(H 群:n=75)と中等度インスリン抵抗性を有する群(M 群:n=64)およびインスリン抵抗性を有さない群(L 群:n=109)に分類し,定量的冠動脈造影を用いて再狭窄率および再狭窄関連因子について検討した.結果:再狭窄率はH 群で有意に高かった(p=0.0005).慢性期最小血管径はH 群で他の2 群と比較して有意に小さかった(H:1.62±1.02 mm,M:2.42±0.48 mm,L:2.17±0.70 mm, p=0.0086).さらに%狭窄率はH 群で他の2 群と比較して有意に大きく(H:40.1±34.7%,M::14.7±10.4%,L:22.7±21.6%, p=0.0092),晩期損失径もH 群で他の2 群と比較して有意に大きかった(H:0.87±0.90 mm,M:0.19±0.17 mm,L:0.41±0.62 mm, p=0.0097).結論:高度インスリン抵抗性は,DES 留置後再狭窄の危険因子となりえると考えられた.INTRODUCTION: Percutaneous coronary intervention (PCI) has beenwidely adopted as an effective treatment strategy for patientswith ischemic heart disease;especially, restenosis issuppressed after drug-eluting stent (DES) implantation.However, coronary artery restenosis after DES implantationstill appear now and then. The aim of this study was toclarify the factors associated with coronary artery restenosisafter DES implantation and evaluate the homeostasismodel assessment of insulin resistance (HOMA-IR) indexas a predictor of restenosis.METHODS: We reserched the clinical records of 248 patients who hadbeen subjected to elective PCI and DES implantation betweenMay 2007 and December 2010. We divided these patientsby the value of HOMA-IR into three groups(GroupH;HOMA-IR≧5 . 0 , Group M;2 . 5≦HOMA-IRHOMA-IR), and examined the relationshipbetween coronary artery restenosis and HOMA-IR.RESULTS: The rate of restenosis was significantly higher in GroupH (26.7 %) than in the other two groups (M;7.8 % andL;8.3%, p=0.0005 %). Follow up MLD was significantlylower in Group H (H;1.62±1.02 mm v.s. M;2.42±0.48 mm v.s. L;2.17±0.70 mm, p=0.0086). Furthermore, %stenosis and late lumen loss was significantly higher inGroup H (H;40.1±34.7%, M;14.7±10.4%, L;22.7±21.6%, p=0.0092, and H;0.87±0.9 mm v.s. M;0.19±0.17 mmv.s. L;0.41±0.62 mm, P=0.0097). Logistic analysis showedthat the only independent predictor of restenosis was HOMA-IR over 5.0( OR 2.87;p=0.004).CONCLUSION: The results suggested that severe insulin resistance wasa predictor of restenosis after drug-eluting stent implantation;furthermore, that improvement of insulin resistancemay contribute to prevent coronary restenosis after drugelutingstent implantation

インスリン テイコウセイ カラ ミタ ヤクザイ ヨウシュツセイ ステント リュウチ ゴ ノ late catch up ゲンショウ ニ ツイテノ ケントウ

目的:虚血性心疾患の危険因子としてメタボリックシンドロームが注目されているが,その背景にはインスリン抵抗性が存在している.一方,虚血性心疾患の治療において経皮的冠動脈形成術(percutaneouscoronary intervention:PCI)は有用な治療法であるが再狭窄が課題である.近年薬剤溶出性ステント(Drugelutingstent:DES)が臨床応用され再狭窄は減少しているものの,ステント血栓症や晩期再狭窄であるlatecatch up 現象などの慢性期における新たな課題が散見されている.今回我々はインスリン抵抗性とDES 留置患者の慢性期の心血管イベントの関連を調べるためにインスリン抵抗性をHomeostasis Model Assessment 指数(HOMA-IR)を用いて検討した.方法:2004 年8 月より2008 年11 月までにPCI を施行しDES を使用した109 例についてHOMA-IR を計測しインスリン抵抗性を認める群(P 群:n=63)と認めない群(N 群:n=46)にわけ慢性期における心血管イベントについて検討した.結果:観察期間は平均で5.48±1.30 年であった.心臓死,再狭窄,心筋梗塞,脳梗塞,心不全,ステント血栓症においては両群間において有意差を認めなかった.しかしlate catch up 現象においてはP 群12.7%とN 群2.2%と有意差を認めた(p=0.048).結論:インスリン抵抗性はDES 留置後のlate catch up 現象の予測因子であった.インスリン抵抗性を改善させることにより慢性期における心血管イベントのさらなる減少が期待される.PURPOSE:Percutaneous coronary intervention( PCI) isan effective treatment for patients with ischemic heart disease;especially, restenosis is suppressed after drug-elutingstent (DES) implantation. However, several problemsstill remain. Previously, we reported neo-intimal proliferationafter DES implantation that was associated with insulinresistance. The aim of this study was to clarify whether insulinresistance was associated with Major Adverse Cardiacand Cerebrovascular Events (MACCE) after DES implantation.METHODS:We researched the clinical records of 109patients who had been subjected to elective PCI and DESimplantation between May 2007 and December 2010. Wedistributed these patients by the value of homeostasis modelassessment of insulin resistance (HOMA-IR) into aGroup P (n=63;HOMA-IR &#8805; 2.5, positive) and a Group N(n=46;HOMA-IR<2.5, negative), and examined the relationshipbetween HOMA-IR and MACCE.RESULTS:The observation period was 5.48±1.30years. There were no differences between the two groupsin the occurrence of cardiac death, restenosis, stroke, acutemyocardial infarction, heart failure and stent thrombosis.But late catch-up phenomenon in group P was significantlyhigher than in group N (12.7 % vs 2.2 % p=0.042). The logisticanalysis showed that the only independent predictorof late catch-up phenomenon was insulin resistance (OR6.55;95 % CI 0.79-54.32, p=0.049).CONCLUSION:We suggest that insulin resistance is auseful predictor of late catch-up phenomenon;furthermore,improvement of insulin resistance may contribute toprevent late catch-up phenomenon after DES implantation